WARD TOPIC DISCUSSION

EGO DEFENSES IN PSYCHIATRIC

DISORDERS

Ms. Alisha Arora

Ph.D. Clinical Psychology Scholar
CIP, Ranchi
 DEFINING EGO DEFENSE

Ego defense mechanisms are unconscious psychological

processes that help an individual to prevent anxiety when exposed

to a stressful situation.
WHAT THE HISTORY SAYS
 Freud’s conceptions of the function of defense was subsequently reconciled by
Anna Freud (1936)- broader purpose of protecting the ego by “warding off”
anxiety and guilt feelings.

 Further distinctions were made between the need to protect the ego from internal
and from external sources of danger.

 Internal danger—“dread of the strength of the instincts” (A. Freud, 1936)—

“instinctual anxiety” .

 External danger to the ego was said to occur when children fear to disobey
parents’ prohibitions, resulting in “objective anxiety”

 or, in adults, “superego anxiety,” in which the internalized conscience is the

source of the prohibitions.
 PART OF NORMAL DEVELOPMENT TOO ?
• Defense mechanisms are part of “the normal human mind” and
are considered to be essential for normal psychological
development.

• There is evidence that coping mechanisms may be associated with

increased emotional distress and other negative outcomes (Watson
& Hubbard, 1996).

• Thus, coping and defense mechanisms cannot be differentiated

on the basis of normality and pathology
GEORGE VALLIANT’S CLASSIFICATION (1994)

LEVEL 1: PATHOLOGICAL

LEVEL 2: IMMATURE

LEVEL 3: NEUROTIC

LEVEL 4: MATURE
PATHOLOGICAL DEFENSES

• Almost always are severely pathological.

• Permit one to effectively eliminate the need to cope with

reality.

• Pathological users frequently appear irrational.

• Common in overt psychosis, but found in dreams and

throughout childhood as well.
Delusional Projection: Grossly frank delusions about external
reality, usually of a persecutory nature.

Denial: Refusal to accept external reality because it is too

threatening; arguing against an anxiety-provoking stimulus by
stating it doesn't exist; resolution of emotional conflict and reduction
of anxiety by refusing to perceive or consciously acknowledge the
more unpleasant aspects of external reality.

Distortion: A gross reshaping of external reality to meet internal

needs.
.
Splitting: A primitive Defense. Negative and positive impulses are

split off and unintegrated. Fundamental example: An individual

views other people as either innately good or innately evil, rather

than a whole continuous being.

Extreme projection: The blatant denial of a moral or psychological

deficiency, which is perceived as a deficiency in another individual

or group
 IMMATURE DEFENSES

• Often present in adults and more commonly in adolescents.

• Lessen anxiety provoked by threatening people or by

uncomfortable reality.

• Excessively use results in socially undesirable, immature,

difficult to deal with behavior, often seriously out of touch
with reality.

• Often seen in severe depression and personality disorders.

Acting out: Direct expression of an unconscious wish or impulse in

action, without conscious awareness of the emotion that drives that

expressive behaviour.

Fantasy: Tendency to retreat into fantasy in order to resolve inner and

outer conflicts.

Idealization: Unconsciously choosing to perceive another individual

as having more positive qualities than he or she may actually have.

Passive aggression: Aggression towards others expressed indirectly
or passively such as using procrastination.

Projection: Projection is a primitive form of paranoia. Reduces

anxiety by allowing the expression of the undesirable impulses or
desires without becoming consciously aware of them. Attributing
one's own unacknowledged unacceptable/unwanted thoughts and
emotions to another

Projective identification: The object of projection invokes in that

person precisely the thoughts, feelings or behaviours projected.

Somatization: The transformation of negative feelings towards others

into negative feelings toward self, pain, illness, and anxiety.

Hypochondriasis
 NEUROTIC DEFENSES

• Fairly common in adults, have short-term advantages in coping,

but can often cause long-term problems in relationships, work

and in enjoying life when used as one's primary style of coping

with the world.

Displacement: Shifts sexual or aggressive impulses to a more
acceptable or less threatening target. Redirecting emotion to a safer
outlet. Separation of emotion from its real object and redirection.

Dissociation: Temporary drastic modification of one's personal identity

or character to avoid emotional distress; separation or postponement of
a feeling that normally would accompany a situation or thought.

Intellectualization: A form of isolation; concentrating on the

intellectual components of a situation so as to distance oneself from the
associated anxiety-provoking emotions; separation of emotion.
Isolation: Separation of feelings from ideas and events.

Rationalization: Where a person convinces him or herself that no wrong

was done and that all is or was all right through faulty and false
reasoning.

Reaction formation: Converting unconscious wishes or impulses that are

perceived to be dangerous into their opposites; behaviour that is
completely the opposite of what one really wants or feels.

Regression: Temporary reversion of the ego to an earlier stage of

development.
Repression: The process of attempting to repel desires towards
pleasurable instincts, caused by a threat of suffering if the desire is
satisfied; the desire is moved to the unconscious in the attempt to
prevent it from entering consciousness.

Undoing: A person tries to 'undo' an unhealthy, destructive or otherwise

threatening thought by engaging in contrary behaviour.

Withdrawal: Withdrawal is a more severe form of defense. It entails

removing oneself from events, stimuli, interactions, etc… that could
remind one of painful thoughts and feelings.
 MATURE DEFENSES
• Commonly found among emotionally healthy adults.

• Optimize success in life and relationships.

• Use enhances pleasure and feelings of control, integrate

conflicting emotions and thoughts, while still remaining
effective.

• Use is generally considered virtuous.

Altruism: Constructive service to others that brings pleasure and
personal satisfaction.

Anticipation: Realistic planning for future discomfort.

Humour: Overt expression of ideas and feelings (especially those that

are unpleasant to focus on or too terrible to talk about) that gives
pleasure to others. The thoughts retain a portion of their innate distress,
but they are "skirted round" by witticism.
Sublimation: Transformation of negative emotions or instincts into
positive actions, behaviour, or emotion.

Thought suppression: The conscious process of pushing thoughts

into the preconscious; the conscious decision to delay paying
attention to an emotion or need in order to cope with the present
reality; making it possible to later access uncomfortable or distressing
emotions while accepting them.

Asceticism: Elimination of directly pleasurable affects attributable to

an experience. Moral element is implicit in setting values.
 DISORDER COMMONLY USED DEFENSES

OBSESSIVE COMPULSIVE DISORDER Isolation, Undoing, And Reaction Formation

DEPRESSION Denial, Projection, Idealization and Devaluation,

Passive Aggression, Identification, Reaction
Formation
DISOCIATIVE DISORDERS Dissociation, Repression, Intellectualization,
Splitting

PANIC DISORDER Reaction Formation And Undoing

CLUSTER C PERSOANLITY Displacement, Rationalization

BORDERLINE PERSONALITY DISORDER Splitting of self and other's images, Dissociation

and Repression
 NARCISSISTIC PERSONALITY Omnipotence, Devaluation, Splitting
DISORDER
ANTISOCIAL PERSONALITY DISORDER Devaluation, Denial

PAIN DISORDERS Regression, Compensation and

Displacement.
EATING DISORDERS Regression, denial, projection, repression,
introjection, intellectualization
SCHIZOPHRENIA Splitting and Projective identification
 REFERENCES
Albucher, R. C., Abelson, J. L., & Nesse, R. M. (1998). Defense mechanism changes in successfully
treated patients with obsessive-compulsive disorder. American Journal of Psychiatry, 155(4), 558-559.

Perry, J. C., Presniak, M. D., & Olson, T. R. (2013). Defense mechanisms in schizotypal, borderline,
antisocial, and narcissistic personality disorders. Psychiatry: Interpersonal & Biological Processes, 76(1),
32-52.

Johansen, P. Ø., Krebs, T. S., Svartberg, M., Stiles, T. C., & Holen, A. (2011). Change in defense
mechanisms during short-term dynamic and cognitive therapy in patients with cluster C personality
disorders. The Journal of nervous and mental disease, 199(9), 712-715.

Beghi, M., Negrini, P. B., Perin, C., Peroni, F., Magaudda, A., Cerri, C., & Cornaggia, C. M. (2015).
Psychogenic non-epileptic seizures: so-called psychiatric comorbidity and underlying defense
mechanisms. Neuropsychiatric disease and treatment, 11, 2519.

Heldt, E., Blaya, C., Kipper, L., Salum, G. A., Otto, M. W., & Manfro, G. G. (2007). Defense mechanisms
after brief cognitive-behavior group therapy for panic disorder: One-year follow-up. The Journal of
nervous and mental disease, 195(6), 540-543.
Landmark, T., Stiles, T. C., Fors, E. A., Holen, A., & Borchgrevink, P. C. (2008). Defense
mechanisms in patients with fibromyalgia and major depressive disorder. The European Journal of
Psychiatry, 22(4), 185-193.

Cramer, P. (2000). Defense mechanisms in psychology today: Further processes for

adaptation. American Psychologist, 55(6), 637.

Leichsenring, F. (1999). Primitive defense mechanisms in schizophrenics and borderline

patients. The Journal of nervous and mental disease, 187(4), 229-236.

Vaillant, G.E (1993). Maturity of ego defense in relation to DSM-III axis personality disorder
Archives of general Psychiatry, 42(6), 597-601